Q: Dr. Eppley, I have a wide chin and am interested in a chin narrowing procedure. What is the best way to make the chin bone more narrow?
A: The benefits of chin narrowing is very clear as you do have a boxy square chin. To obtain substantial chin narrowing there are two basic techniques, bony genioplasty wedge (sliding genioplasty with central wedge reduction) and lateral tubercle ostectomies. (cut off the corners without down fracturing the chin) There are advantages and disadvantages of each method of chin narrowing. Having done them both numerous times, they both can work but there are subtle differences between them that can carry aesthetic consequences. The advantage of the bony genioplasty wedge reduction method is that it does not strip off all the attached soft tissues so the risk of the soft tissues not adequately reattaching afterwards is minimized but it is a ‘bigger’ operation due to the need to down fracture the bone and the bone cuts come closer to the exit of the mental nerve from the bone. (risk of numbness) The lateral tubercle ostectomy method merely cuts off the corner of the boxy chin and does not need to down fracture the chin bone and thus there is no need for plates and screws to put it back together. Its bone cuts stay further from the mental nerve so the risk of lip numbness is less. Its disadvantage is that it may not produce as significant a chin narrowing effect and detaches more of the soft tissue.
Dr. Barry Eppley
Q: Dr. Eppley, I am an Asian female who is 27 years old and want to have a more narrow face. I’m interested in jaw reduction, chin reduction(v-line) and cheekbone reduction surgeries. What are the possibilities of side-effects such as nerve damage and sagging skin? Is it possible to do all 3 surgeries at once?
A: As you undoubtably know, narrowing of the Asian face by bone reduction is a common request and collection of procedures. All three facial bone reduction procedures are commonly done together including cheek bone reduction and jawline narrowing. The most common side effect, albeit not a complication, is the protracted facial swelling (4 to 6 weeks) until you see the beginnings of the results of the procedure. Generally permanent nerve damage (sensory nerves, infraorbital and mental nerves) does not occur although there will be a period of some lip numbness. The bigger risk is with the mental nerve as the jawline reduction goes right beneath it and some stretch on the nerve does occur. Sagging skin is also not usually an issue either and this is more of a concern in the cheek area rather than the jawline.
Dr. Barry Eppley
Q: Dr. Eppley, Where do you do surgery? What are the facility fees? What would the price be to narrow or burr the chin just at the bottom edges to make it look less square? Also, I have a flat forehead in the center with prominent eyebrow muscle, which makes the flat forehead area look flatter. How wold you fill in the flat forehead or the center of the forehead in a female? Fat injections? What would the price be?
And can you shorten the forehead skull if the hairline is a little high?
A: In answer to your questions:
1) My cosmetic surgeries are done in a private outpatient cosmetic surgery center. The operating room and anesthesia fees are based on the time that it takes to perform the procedure(s). That must be determined on an individual patient and the specific procedures they are having.
2) Narrowing the chin is done by intraoral ostectomies or removing the sides of the chin through a reciprocating saw technique.
3) A flat glabellar area can be built up by a variety of techniques with fat injections being the simplest to perform.
4) If one’s frontal hairline is too high, its length is not going to be lowered by reducing the height of the skull as that amount of skull height reduction can not be done. Shortening the long forehead is done by a procedure known as scalp or frontal hairline advancement.
I will need to first review some pictures of your face to see exactly what needs to be done before the costs of the procedures can be provided.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in getting my chin narrower as it is too wide from the front view. In addition, it is longer on one side than the other. I know that you can burr or shave down the chin to reshape it. I have some concerns and questions about the procedure.
1. I want my chin to be narrower by at most 1/4 inch. I want the same squared shape only narrower from the frontal point of view. Is that easier to do by cutting out a long narrow vertical strip in the middle of the chin and pushing the sides together thus preserving squareness or is it just better to burr down tubercles of chin on outer edges? I do NOT want a pointy chin nor an oval chin. Slight square is better just like it is, but narrower. Don’t know how narrowing would change smile lines as they arise from chin though. Nor am I clear of how the jawbone to chin transition would change in a burring. May be difficult to preserve some squareness. Don’t want too small a chin for my size. I also fear that a subsequent face lift will feature a prominent bony masculine chin.
2. I do NOT want my chin profile to be changed. I think it is fine as is. Would burring down of sides affect this?
3. Also want the bottom of the chin to be evened out. One side is longer than the other. Hopefully the asymmetry in the rest of my face (the right side is fuller in the cheeks) won’t be accentuated by any chin narrowing.
4. Will intra-oral approach allow you to visualize the submental nerve adequately? Will it increase chance of infection?
5. Percent likelihood of numbness of chin? Tongue? Typical resolution time? Ever seen permanent numbness?
6. What is most catastrophic thing that could go wrong with a chin reduction? Lower face paralysis or worsening of my already incompetent lower lip?
A: In answer to our questions:
1) It is better to simply burr down the side of the chin for such a small amount of chin narrowing. Technically I actually use a reciprocating saw to remove the bone. That stills keeps it square in the front view, just narrower by the amount removed. I don’t think this would have any great impact on the smile lines nor change the jawline-chin transition…it is just being made slightly smaller/narrower in the frontal view. Also, a facelift does not really pull and shift tissues in the chin area so I don’t think that it will accentuate or create more of a square chin appearance.
2) Taking down the sides of the chin will not affect its horizontal projection. (profile) The most projecting part of the chin bone is not being affected.
3) The longer vertical side of the chin can be reduced as well. The computer imaging done previously should show you what the impact the chin surgery has on the look of the rest of your face.
4) The intraoral approach will allow the mental nerves to be seen completely. Intraoral surgery does nto increase the risk of infection unless an implant is being placed. There is nothing wrong with going from beow the chin through a skin incision, it is just that it is not necessary. (no advantages in doing so)
5) There will always be some temporary numbness of the chin because the mental nerves have been exposed. I have not seen permanent numbness from an isolated chin reduction/burring procedure. No risk of tongue numbness, the tongue is innervated from the lingual on the floor of the mouth which is a long way away.
6) There are no catastrophic events that can happen from this procedure. It is just an issue of aesthetics, how close do we come to the desired aesthetic goal. Lower facial paralysis is an impossibility because the facial nerve the moves the face is back near the ear. If your lower lip is incompetent to some degree I will resposition the mentalis muscle and chin soft tissues to try and improve that problem at the same time.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 52 year-old female and am interested in reshaping my chin. I have always been bothered a bit by the squareness of my chin which is a bit unfeminine.with aging But now that I have developed some jowling, it makes my face look more square. I want to get my chin reshaped to a more narrow appearance and then have a facelift afterwards. How would this be done and how far apart should the chin reshaping and facelift be? I have attached some pictures and have done a ‘homemade’ facelift by pulling up on my skin so you can see the squareness of the chin better.
A: Thank you for sending your photos. Your homemade facelift shows the exact location of the squareness of your chin. Now that I know the location of bony excess, that would be best reduced by an intraoral approach given that it is fairly anterior. It would be reshaped by a saw technique, taking off the wings of the chin. I have done an image showing its reduction result, more can be done but this is a good starting point for discussion. Given its very anterior location and away from the plane of dissection of a facelift, I see no reason why the two procedures could not be done at the same time. The distal tightening effect of the facelift would help any soft tissue slack/swelling that would occur from the chin ostectomy/reshaping.
Dr. Barry Eppley
Q: Dr. Eppley, I am investigating the possibility of narrowing my wide chin. I am 55 years old and have noticed the characteristic age-related lower face widening as a result of the increasing tissue laxity. While I am planning a facelift within the next year or so, I think a narrower chin will look nicer, more feminine and less bony once I have the jowls tightened. I have the following questions.
1) Am I a candidate for the submental approach and would this involve just burring down the sides of my chin? (I think my profile is fine and don’t need an implant)
2) Wait time after chin reduction before a lower facelift could be done.
3) Likelihood of complete resolution of any numbness? And additional risks due to my age?
A: 1) I would have to see pictures to determine your candidacy for the procedure. But usually the submental approach is best due to better access to the bone with a minimal risk of any nerve injury. If side chin reduction is only needed, an ostectomy with a saw for narrowing would be the technique used.
2) If one has to stage it, the chin reduction would be done first with a minimum three month delay before the lower facelift. The two procedures could also be combined.
3) When done from below, the mental nerve is well visualized so permanent injury to it is unlikely. Simple stretching and elevation of the soft tissues off of the bone will likely cause some mild temporary numbness or none at all. Other than the age-independent risk of mental nerve neuropraxia, I can foresee no other significant risks other than achieving the desired chin shape.
Dr. Barry Eppley
Q: I am a male to female transsexual and need some facial changes as part of the process. My chin is too male looking with a prominent chin cleft and it is very wide. It is too wide and prominent for my face which i am trying to make more feminine and slender. I need my chin cleft removed and the width of the chin corrected by burring it down from inside the mouth.
A: In trying to achieve a more feminine looking chin, your aesthetic goals are correct but the method to get there is not the best way. Simple intraoral burring of the chin can only make a minimal narrowing effect and, if done aggressively, will like result in soft tissue sagging problems. The best approach to really narrow and taper the bony chin is through the use of an osteotomy. By doing a horizontal chin osteotomy, the downfractured segmented can be split in the middle and a center segment of chin bone removed. It can then be put back together with the entire chin significantly narrowed and with a much better tapered look to it. The chin soft tissues can then be better suspended with no risk of soft tissue sag (witch’s chin deformity) afterwards. This will also provide a better means of muscle tightening and soft tissue fill of the chin cleft to create a better chin cleft soft tissue reduction. While this sounds complicated, it is just a simple variation of the traditional chin osteotomy technique. (genioplasty without the side)
Dr. Barry Eppley